The effect of auditory stress on perception of intraesophageal acid in patients with gastroesophageal reflux disease
The effect of auditory stress on perception of intraesophageal acid in patients with gastroesophageal reflux disease
复制标题
DOI：
10.1053/j.gastro.2007.12.010
复制
发表时间：
2008-03-01
期刊：
影响因子：
29.4
通讯作者：
Mayer, Emeran A.
中科院分区：
文献类型：
--
作者：
Fass, Ronnie;Naliboff, Bruce D.;Mayer, Emeran A.
背景和目标：大多数胃食管反流病（GERD）患者报告说，压力加剧了他们的症状，但这种关联的机制仍然未知。我们试图确定急性实验室应激源对健康对照组和GERD患者食管内酸灌注的感知和情绪反应的影响。方法：46例胃灼热患者和10名健康对照者接受上消化道内镜检查，如果阴性，则进行pH监测。采用问卷调查的方式对患者的心理因素和健康相关生活质量进行评估。采用随机交叉设计，确定了在基线、听觉应激和听觉控制条件下对食管内酸的感知和情绪反应。评估血浆去甲肾上腺素、促肾上腺皮质激素和皮质醇水平。结果：29例被确定为非糜烂性反流病和17例糜烂性食管炎。两组患者的生活质量、心理状况和人格评估变量与对照组相似。有一个显着减少的平均滞后时间，以最初的症状感知和增加的平均强度等级和平均酸灌注敏感性评分在2个患者组在应激期间。这在对照条件下是看不到的。健康对照组表现出缺乏一个显着的变化，在所有参数的刺激响应功能酸，无论条件。结论：急性听觉应激可通过增强对食管内酸暴露的感知反应而加重GERD患者的烧心症状。这种更大的感知反应与对压力源的更大的情绪反应有关。
Background&Aims: Most patients with gastroesophageal reflux disease (GERD) report that stress exacerbates their symptoms, yet mechanisms underlying this association remain unknown. We sought to determine the effect of an acute laboratory stressor on perceptual and emotional responses to intra-esophageal acid perfusion in healthy controls and patients with GERD. Methods: Forty-six patients with heartburn and 10 healthy controls underwent upper endoscopy and, if negative, pH monitoring. Assessment of psychologic factors and health-related quality of life was done by a questionnaire. Perceptual and emotional responses to intraesophageal acid at baseline, during auditory stress, and during an auditory control condition were determined using a randomized crossover design. Plasma levels of norepinephrine, adrenocorticotropic hormone, and cortisol were assessed. Results: Twenty-nine subjects were identified as nonerosive reflux disease and 17 as erosive esophagitis. Quality of life, psychologic profile, and personality assessment variables were similar among the 2 patient groups and the controls. There was a significant reduction in mean lag time to initial symptom perception and an increase in mean intensity rating and mean acid perfusion sensitivity score in the 2 patient groups during the stress period. which was not seen during the control condition. Healthy controls demonstrated lack of a significant change in all parameters of stimulus response functions to acid, regardless of condition. Conclusions: Acute auditory stress can exacerbate heartburn symptoms in GERD patients by enhancing perceptual response to intraesophageal acid exposure. This greater perceptual response is associated with greater emotional responses to the stressor.